Provider Demographics
NPI:1205260841
Name:JOHN R EXPRESS PHARMACY PC
Entity type:Organization
Organization Name:JOHN R EXPRESS PHARMACY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JADALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-268-3302
Mailing Address - Street 1:26100 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3648
Mailing Address - Country:US
Mailing Address - Phone:248-268-3302
Mailing Address - Fax:248-268-3317
Practice Address - Street 1:26100 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3648
Practice Address - Country:US
Practice Address - Phone:248-268-3302
Practice Address - Fax:248-268-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy